NHSE told us that it had struggled to get the clinical community uniformly behind the outpatients programme and that engagement had also been highly variable from specialty to specialty. We heard from the Department and NHSE that in their view the outpatients programme required extensive change to the way everyone in an acute hospital works, from clinicians to administration staff. The fundamental nature of these changes, we heard, meant that industrial action caused significant disruption to the ability of the programme to make progress at the operational level.52 NHSE told us that it had not applied all of the expertise available to them and accepted that it had not communicated the opportunity for change that it sees in the outpatients programme. The NAO report found that while NHSE recognised that progress towards outpatients targets had been slow by September 2022, it did not reset the programme until 2024.53 49 The Royal College of Radiologists (NWT0002); Royal College of Physicians (NWT0025); The Royal College of Ophthalmologists (NWT0032) 50 C&AG’s Report, paras 17, 4.9 51 C&AG’s Report, para 4.9 52 Q 45 53 C&AG’s Report, para 4.10 14